Wel, Jennifer, it sounds like your first consult was a doozy. What an awful
start this poor baby had.

As for the shield, unfortunately in my experience many women do not get
their nipples more than half-way into the shield. I almost always use the
24mm shield, so baby has a chance at pulling more of mom into the shield as
he suckles.  But many babies who need a shield to latch cannot remove milk
very well. I think it is usually because they do not suck very well (as it
sounds like is the case with this baby) and sometimes because the shield
keeps them from latching deeply enough to really get to the breast.

As for this consult, what does the baby weigh compared with birth weight? Is
he term? How much milk is he transferring at breast? Is mom pumping with a
hospital-grade pump?  You cannot trust a baby like this to remove milk well
enough over the long-haul.  Very often baby will fool everyone by gulping
the milk mom ejects into the shield at first, but as her milk supply
gradually diminishes (because he is not participating in the removal) so
does the weight gain.  Then at the 3 week or 2 month check the weight gain
has stopped and moms supply is severely compromised..  It is helpful to see
the pre and post weights gradually decreasing over time and the weight gain
slowing to prove this is happening, so enough pumping is done.


Kathy Leeper, MD, IBCLC, FABM
Medical Director
MilkWorks-nonprofit breastfeeding support center
Lincoln, NE

*Creating a healthier community by helping mothers breastfeed their
babies....*
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